Joints of the Lower Limb Flashcards
Osteoarthritis
Degeneration of articular cartilage.
Common in the elderly and former athletes.
Loss of cartilage allows bones to directly articulate with each other which produces pain and decreases function.
X-ray findings of osteoarthritis
joint space narrowing and osteophytes
Treatment of osteoarthritis
Stepwise from least invasive to most invasive
rest, activity modification, NSAIDs, physical therapy->steroid or hyaluronic acid injection->surgery (arthrodesis or arthroplasty)
Hip Joint- Type
Ball and Socket Synovial
Hip Joint- Bones involved
Acetabulum of Os Coxa and Head of the Femur
Acetabulum- composition
Composed of the fusion of the ilium, ischium, and pubis to make a cup shaped socket socket for the head of the femur
Lunate (articular) surface of acetabulum
Deep Surface covered in articular cartilage. as a non-articulating surface in the middle called the acetabular fossa.
Acetabular Labrum
Fibrocartilage extension of the rim of the acetabulum.
Transverse acetabular ligament
Spans the acetabular notch.
Is continuous with the acetabular labrum.
Labrum + Transverse acetabular ligament
Increased depth of the acetabulum and increased contact w/ head of femur.
Round Ligament of head of femur
- Primarily a synovial fold. Also contains a small brach of the obturator artery.
- Spans the acetabular notch to the fovea capitis
- NOT a significant contributor to blood supply or stability.
Hip Capsule
The reason the hip is so stable.
Hip Capsule origins and insertions
Bony rim of the acetabulum and the
transverse acetabular ligament to the intertrochanteric line anteriorly and posteriorly it crosses the femoral neck above to the intertrochanteric crest
Does NOT attach to the neck
Bursa for the obturator externus tendon
Lack of attachment of the distal/posterior aspect of the hip capsule allows a protrusion of the synovium
Iliofemoral ligament
Anterior/ superior part of hip capsule.
Made of 2 bands-
1. Superior: AIIS and superior brim of acetabulum to greater trochanter
2. Inferior: AIIS and Superior brim of acetabulum to Lesser Trochanter
The 3 ligaments of the Hip Capsule
- Illiofemoral Ligament
- Pubofemoral Ligament
- Isciofemoral Ligament
Iliofemoral ligament function
Strongest of the hip capsule ligaments
Provides anterior joint support
Helps prevent hyperextension of the thigh
Tightens during hip extension
One reason posterior hip dislocations are more common then anterior.
Pubofemoral Ligament
Anterior/inferior part of the hip capsule.
Obturator cost of the superior pubic crest and then blends with Iliofemoral Ligament.
Ischiofemoral Ligament
- Posterior part of hip capsule
- Ischial acetabular rim to superior femoral neck just medial to base of trochanter.
- Is weakest and does not provide great coverage- why posterior hip dislocations are more common then anterior.
Zona Orbicularis
Deep fibers of the capsule that wind circularly around the femoral neck
Most noticeable in the posterior aspect of the capsule
Why is there significantly increased ROM during hip flexion as opposed to hip extension?
The ligaments of the joint capsule pass in a spiral fashion from the pelvis to the femur and tighten, drawing the head of the femur into the acetabulum, during thigh extension
Blood supply to the hip capsule
Cruciate Anastamosis
Medical Femoral Circumflex A-
Branch of obturator a via the round ligament of the head of the femur.
Major Blood Supply to head and neck of the femur?
medial femoral circumflex a. specifically its retinacular branches
Fracture or dislocation of head and neck of femur complications?
- Can cause avascular necrosis if branches of medial circumflex a. is disrupted. Treatment is total hip replacement.
- sciatic nerve injuries
Posterior Hip Dislocations
- 90% of all hip dislocations
- Most often caused by trauma to a flexed hip (because the capsule is loosened during flexion and the femoral head is not tight within the acetabulum)
- affected leg is shortened, adducted, and internally rotated
Knee Joint
- Modified Hinge Synovial Joint
- Flexion and extension of the leg with minimal amounts of gliding and rotation
Bony Articulations of the knee (3)
-2 femorotibial articulations between the medial and lateral femoral and tibial condyles
-1 femoropatellar
All lined with articular cartilage
Lateral and Medical Menisci
- Sit on top of lateral and medical tibial condyles
- composed of fibrocartilage and deepen the articulation
- Help prevent dislocation
- Act as shock absorber for knee
Transverse genicular ligament
Attaches the anterior horns of both menisci to each other and the tibia to help stabilize the menisci by preventing them from being pulled apart during weight bearing
The femoropatellar articulation
Gliding joint between the patella and the femur
Medial and lateral patellar retinacula
aponeurotic extensions of the vastus medialis and lateralis that extend from either side of the patella to blend with the rest of the capsule
Lateral collateral ligament (LCL)
AKA fibular collateral ligament
1. strong, cord-like structure extending from the lateral epicondyle of the femur to the lateral surface of the head of the fibula
- The tendon of the popliteus muscle travels deep to the LCL separating it from the lateral meniscus
- Test integrity with varus stress
Medial collateral ligament (MCL)
AKA tibial collateral ligament
a. Strong, flat, broad ligament extending from the medial epicondyle of the femur to the superomedial surface of the tibia
b. At its midpoint, the deep fibers of the MCL directly attach to the medial meniscus. This attachment is the reason medial meniscus tears frequently occur in conjunction with MCL tears
c. Test integrity with valgus stress
Oblique popliteal ligament
- A reflection of the semimembranosus tendon over the posterior aspect of the capsule travelling in an inferomedial -> superolateral direction
- Blends with the posterior aspect of the capsule to strengthen it
Arcuate popliteal ligament
Travels in an inferolateral to superomedial direction from the fibular head->arcs over the popliteus tendon->blends with the oblique popliteal ligament and the rest of the posterior aspect of the capsule to provide added strength
3 intracapsular knee ligaments
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)
Meniscofemoral ligament